Provider Demographics
NPI:1164432100
Name:KIDS & TEENS PRIMARY HEALTH CARE OF ATLANTA, P.C.
Entity Type:Organization
Organization Name:KIDS & TEENS PRIMARY HEALTH CARE OF ATLANTA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:CEDRIC
Authorized Official - Last Name:COTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-875-4261
Mailing Address - Street 1:1462 MONTREAL RD
Mailing Address - Street 2:STE 212
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6929
Mailing Address - Country:US
Mailing Address - Phone:404-875-4261
Mailing Address - Fax:770-939-7750
Practice Address - Street 1:1462 MONTREAL RD
Practice Address - Street 2:STE 212
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6929
Practice Address - Country:US
Practice Address - Phone:404-875-4261
Practice Address - Fax:770-939-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041098208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty